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Thank you for being such lovely owners and clients this year. Just a quick update…

Clinic Hours over Christmas:

New addition to Combined Physio: Hannah has taken on a new rescue dog, Arya, who you can see below.

Towels and Treats: We would greatly appreciate it if you could bring your own towels and treats to the sessions. This helps us save on water and electricity in washing the towels. It also ensures your dog is receiving appropriate treats for him or her.

Canine Clinic Times over the Christmas Period

Monday 24th December – no clinic
Tuesday 25th December – no clinic
Wednesday 26th December – no clinic
Thursday 27th December – morning clinic in Banbury
Friday 28th December – no clinic

My plan was to resolve the muscular soreness that he had developed, improve his posture and improve his movement patterning. I did this using laser therapy, neuromuscular electrical stimulation, massage techniques and joint mobilisations.

He had a graded strengthening programme involving ground pole work, long reining before ridden work, and static postural stability exercises. We also had to get the saddle fitter involved to ensure that his saddle was not contributing to any of the soreness.

Patient of the month! Bentley

Bentley came to physiotherapy following a three-month history of left hind intermittent lameness starting at the end of July. Bentley improved initially, but then unfortunately slipped in the house in September and became non-weight bearing lame. In September Bentley was diagnosed with luxating knee caps on both sides and was advised crate rest, anti-inflammatory medication and physiotherapy. He was referred to a secondary veterinary centre for consideration for surgery to stabilise the knee cap.

28th October 2017
On Bentleys’ initial assessment we examined his movement and joint range. We devised a programme of exercises to do at home, treated him with low level laser therapy and habituated Bentley to the underwater treadmill in Banbury. He is a clever boy so realised quickly standing at the side meant he could take it easy. Not to be deterred I climbed into the tank with him to keep him on track.

11th November 2017
Bentley returned two weeks later, his owners fully committed to the home exercise programme of repeated sit to stands, pole exercises and baited stretches. His gait assessment had improved, and his personality was starting to shine through. We progressed the underwater treadmill treatment quickly and started to introduce backwards walking and facilitation of the left hind during the sessions.
Over the next sessions we increased the time out walking, doing exercises and in the beginning of December we re introduced the first ball throw.

14th December
Bentley was due to return to Abington park today for a surgical review but as he was progressing so well the vets decided a non-surgical approach was the way forward.

Since then we have been finding ways to keep Bentleys appetite for activity satisfied, we are still yet to tire him out during a treatment session. Well done Bentley it’s been a pleasure working with you!

Courses

We had the pleasure of going on a fantastic laser or photobiomodulation therapy (as it’s now called) update, with Thor laser in London in December.

Then in February we attended the annual ACPAT conference in Rugby. The after dinner speaker was a vet from Streetvet, which is a great charity providing veterinary care to pets on the street.

Later in the month we also hosted a MSc student equine assessment day to 15 students at Oaklands stable, Tysoe. This was taught by the midsvet physio team of myself, Kathryn Welland, Rachel Cartwright and Fiona Dove.

The easy way to pay

To make life easy for you we accept card payments for the sessions. This saves you having to worry about bringing cash or a cheque. We are still able to produce invoices if you wish to pay by bank transfer.

Follow us on Social Media

In this month’s newsletter we’ve got a recent story about our patient of the year- Digger! You can read more about him below.

This year we have had the pleasure of continuing to work with all of the veterinary practices listed on our website and we thank them for their continued belief in, and support of, combined physio.

Please let us know how you feel about what we have done for you and your animals by leaving a review on our Facebook page.

We would like to make everyone aware of our Christmas opening hours which you will find at the bottom of this newsletter.

Finally we would like to wish all of our clients a Happy Christmas and a prosperous New Year!

Patient of the year! – Digger – a lovely little 5 year old dog.

11th July: He suddenly became paralysed. He was rushed to the vets and then to the veterinary hospital for a secondary opinion. After several tests he was diagnosed with axonal polyradiculoneuritis. This disease appears to be an abnormal immune response to an unknown cause.

He was one of two cases with this disease that we were referred within 2 weeks of each other. Both cases returned to walking within 3 months. We did physiotherapy regularly during that time.

7th August: Hannah saw him for the first time. He was only able to move his head and tail a little at this stage.

31st August: Hannah made some splints for him to prevent contractures. At this time he could independently lie in sternal lying.

6th September: he was crawling around and playing with toys.

22nd September: he took his first steps in the walker.

28th September: he did his first independent sit.

30th September: He walked independently for the first time.

Here is a video of him walking on the 5th October. Although he is still tentative there, he went on to become more confident and is back chasing things again!

Christmas Opening

We be finishing on the 22nd December. Appointments will be available on Saturday 30th December with Fiona at our Banbury clinic. We will be officially starting back on Tuesday 2nd January 2018

This is a two part blog post written in conjunction with John Taylor, veterinary surgeon and owner of Mansion Hill Vets in Middleton Cheney. You can find his post on hip arthritis here.

Do you have a dog with recently diagnosed hip arthritis or dysplasia? Very often the first thoughts are panic or worry. Many owners worry that it has a very poor prognosis. I disagree! There is so much we can do.

Aims of physiotherapy:

relieve pain

control inflammation

maintain strength

optimise normal movement

reduce compensations

In physiotherapy we relieve pain by mobilising the hip joint and surrounding tissues manually and with exercises. This mechanical movement actually blocks pain signals to the brain and stimulates endorphins- you know those lovely feel good/ relaxing hormones you get after a nice massage. Guess what? This effect lasts after the treatment! Mobilising joints and tissues also stimulates blood flow and lymphatics reducing inflammation.

We also use low level laser therapy to help manage pain, inflammation and muscle tension associated with arthritis. This works by slowing down pain signals at the spinal cord, dissipating muscle knots, reducing inflammation and there is some evidence to suggest it can even improve cartilage structure.

It is true that a significant help to the symptoms of arthritis is reducing the weight of your dog if they are overweight. Catch 22! You feel you can’t exercise your dog because they are sore or simply sit down when you try to walk them, so with diet alone it is hard for them to lose weight. This is where physiotherapy really helps, because we can help you and your dog grade your walks whilst helping to manage the pain and inflammation.

It is really important that we help our dogs to keep their muscles strong when arthritis is making the joints painful and swollen. The hip joint relies on the muscle around it to keep it stable. The more stable it is, the less painful it is. Unfortunately pain and swelling stop those muscles from working properly so we need to train them to cope with the new situation. We train these muscles through Pilates type exercises, graded walks and hydrotherapy. This helps pain and inflammation too, as moving the joints and muscles blocks the pain signals and gets the blood moving to whisk away the inflammation.

Hydrotherapy has the added benefit hydrostatic pressure! Hydrostatic pressure in water stimulates cutaneous sensory nerves in the skin/ hair follicles and joint mechanoreceptors. These help to increase joint stability and block pain signals to the brain. This stimulation also encourages increased range of motion in the joints. Hydrostatic pressure can also reduce the effect swelling and pain has on preventing muscle from working. Being in water reduces weight bearing through the arthritic joint, which reduces the pain associated with pressure on damaged cartilage and bone. This allows your dog to move without a limp and stop putting compensatory pressure on the other joints and tissues in the body. The more comfortable we can make your dog, the more normally they will move and the better their other joints will be! Walking in water or swimming also works your dog pretty hard. A 5 minute swim is equivalent to a 5 mile walk! So if you are trying to help your dog lose weight, hydrotherapy is ideal.

Sometimes surgery is necessary because everything else is just not enough, or juvenile pubic symphysiodesis or triple pelvic osteotomy has been performed. The same principles above apply. You can do a hip replacement or a femoral head excision but those muscles will need to be retrained to work to help stabilise the new apparatus. Pain and inflammation is an initial factor following surgery. Low level laser therapy, ice, gentle movements, hydrotherapy (after the wound has healed), and massage can significantly help reduce pain and swelling.

When pain and swelling is under control, the work really begins to help your dog move normally again and stop compensating. Otherwise before you know it, another joint will need surgery! Many dogs have been limping for months before surgery, need help getting out of the habit and to trust that leg again. The earlier you get them moving normally, in a controlled way and doing core strengthening, the better. The new hip will be stronger quicker and the less strain there will be on other joints/ tissues.

Well what a week. Last sunday my horse Bertie and I had great fun doing the Warwickshire team chase midway between Southam and Banbury. We were in a team called Mrs Green’s Girls and had it not been for a couple of mishaps I am sure we would have been the closest to the bogey time. Bertie and I went clear and I am so grateful to my fellow team members for allowing me to be part of the team. Below is my banner, next to the deathly hallows ditch that I sponsored.

This weekend I travelled down to Wales to see my oldest friend to attend their amazing village show. Here is a picture of me having a go on the tractor trailer reversing opposite my far better other half!!!

In the week ahead amongst other things, I am treating a lovely young dark bay gelding with a muscle tear and I am doing a presentation on canine spinal dysfunction to Mansion Hill vets in Middleton Cheney. Wish me luck!

At the end of July I led a horse and rider pilates master class for North Oxfordshire Riding club. Lovely people, cute ponies and gorgeous location in Souldern.

August began with a presentation at midland polocrosse camp at Henley in Arden! I had some great questions whilst assessing one of the ponies from Oaklands Stables, Tysoe with a back problem.

I also started treating a horse post kissing spines surgery, referred nice and early from Towcester vets. He is doing marvellously by the way!

Then… the following week I presented at Warwick dog training club. Here I met some lovely dogs including 2 young cocker spaniels, 1 older cocker spaniel and 2 older staffordshire bull terriers. With problems such as lumbar sacral pain, and hip joint dyfunction. One also had a muscle strain likely from agility.

To top off the end of the month, I will be competing and sponsoring a fence at the Warwickshire team chase this weekend, on the lovely Berty! Photos to follow!

This week I have had to buy some more safety glasses for my laser therapy. Stupidly I have misplaced them in our house renovation. Boy… will I be extra vigilant in the future because they cost £130 a pair!

Any way, I was on the THOR site and came across something that reminded me why I have a 3B laser not a class IV laser.

There are now more and more class IV lasers being used by vet nurses in the UK. I worry if they have the scientific knowledge to understand how to administer laser appropriately.

Last year I completed some masters level research on using laser for dogs with hip joint dysfunction. I found that laser had a significant effect on pain related behaviour. The literature review was extensive and I really had to get my head around the physics!!! However, the recommended dosage is about 6J per point for pain relief. I administer this in 30 seconds per point with my 1W laser. For inflammation the research shows you need a gentler approach with an LED pulsed laser, which I also administer.

The penetration depth I can achieve with my 1W laser is up to 5cm through clear skin. The research to support this is a bit thin, but there is evidence to support superficial use of laser over acupuncture points has a statistically similar effect to acupuncture (Shen et al. 2008), and a better effect than acupressure (Kannan 2012).

If you think your animal may benefit from this then please book now on 07813202038 or email [email protected]

I came across this video the other day (Hoof balance video!), which first of all is just cool. Second of all it shows how energy effects hoof balance. Being a physio though I automatically think of the knock on effect higher up the limb and into the back.

The shire horse at about 50secs in really rotates the forelimbs before placing the hoof, which highlights one reason why differing action in individual horses may have more tension through the thoracic sling than other horses.

There is a great demonstration of medial force about 1.20mins in which highlights why a horse may wear or wing medially more. Again my thoughts directly go to the effect that has higher up (typical physio), on the medial aspect of the hock, stifle, hip and sacroiliac joint. Where farriery can support that action from the bottom, I would want to attempt to balance that action with strengthening the abductors and internal rotators. Otherwise over time that will wear the inside of the joints more causing an imbalance and leading to injury.

What is very clear throughout the video is the amount of extension occurring through the interphalangeal joints, and the pressure that puts on the tendons and ligaments. This highlights the importance of correct shoeing such as Viitanen et al, (2003) who found that elevating the heel by just 5 degrees effected the pressure on the distal interphalangeal joint significantly. However many vets and owners forget about the other end of support. In the human field, if you train the core muscles, such as in Esculier et al (2015), it reduces peak vertical forces through the distal limb joints and tendons. Much research has been conducted on eccentric loading to tendons for tendon rehabilitation but this is not a routine protocol for digital flexor injuries yet. There is of course not a direct correlation between humans and horses but the principal is the same and the tissue is the same. Hydrotherapy is also not able to condition flexor tendons enough alone.

The forces are increased with the hard ground in the summer, so this is the time to be preventing lameness not just with shoeing but with strength and conditioning.

If you have a horse with tendon issues or foot balance problems that you suspect could be causing performance issues then give us a call on 07813202038 to book now.